Mr Tahir Ali undertook his post graduate registrar training in the South West Thames training program having completed his research at St Thomas' Hospital. He was awarded an endovascular fellowship by the Vascular Society upon completion

Mr Ali graduated from Leicester University medical school in 1998 and was jointly appointed as a consultant general and vascular surgeon at Epsom and Ashford and St Peters Hospitals in 2011.

He undertook his post graduate registrar training in the South West Thames training program having completed his research at St Thomas' Hospital. He was awarded a specialist endovascular fellowship by the Vascular Society on completion of his surgical training.

Mr Ali is a conscientious surgeon who provides high quality care and up-to date surgical techniques. He is able to provide the comprehensive management of arterial, venous and systemic circulatory disorders.

Clinic is run twice a week in Epsom outpatients in conjunction with multidisciplinary members from the diabetic foot and the tissue viability teams.
Special interests and treatments

In addition, Mr Tahir Ali also undertakes a range of general surgical procedures including open and laparoscopic hernia surgery, day case surgery and laparoscopic cholecystectomy.

What are varicose veins?

Some of our veins lie immediately beneath the skin and others are hidden from view within the deeper muscle layers of the body. We need our veins to be able to drain blood back to heart, often against gravity, as part of our normal circulation.

Our veins cleverly use a series of delicate in-built valves to achieve this together with the pumping effect of muscles when we are active. We can see that our veins often become prominent when they are required to carry more blood, say during exercise or pregnancy or when we need to cool down during hot weather or at bath time!

However, when the integrity of our delicate valves fails or is overwhelmed, the veins are not only visible but with time become elongated, unraveled and often unsightly. It is this appearance which we describe as 'varicose veins'

Why do varicose veins form?

The component parts of our blood vessels are packaged together whilst we are still growing in the womb. This includes the veins and their valves. How strong or resilient they will be during our lifetime is to a certain extent determined by our genes but is also influenced by the stresses they are required to cope with as we age.

When a vein wall becomes repeatedly overstretched or if the valve apparatus itself fails, the vein accommodates any non-returning blood by becoming tortuous and knotted. Eventually these changes in the vein wall spread to neighbouring segments and branches of the affected vein. These changes are likely to be visible to the naked eye particularly when these veins are in a prominent location such the lower calf where they can be felt as clusters or bulges.

These clusters and bulges are called 'varicosities' and are most commonly seen in the legs particularly when standing up.

We are still unsure of the trigger which causes our veins to become varicosed and it may well be that with time we will find that a specific weakness or defect in the vein or the valve itself it's the underlying factor rather than disturbances caused by high pressure within the vein.

What are the main symptoms of varicose veins?

The majority of varicose veins are annoying rather than being harmful. The symptoms associated with the veins vary in severity for different people and may simply be the annoyance of the visual impact they cause or pain developing in the bulges seen.

Often they cause us to find that our legs tire or ache. Others may find that their legs and ankles are puffy particularly at the end of the day. The affected skin may become itchy or burn. Some people will suffer from restlessness or cramps in the legs which can disturb their sleep.

We have found that one in ten people will have varicose veins which are severe enough to cause concerns to them or their GP or consultant.

In some instances, the condition is associated with the development of changes to the appearance of the overlying skin, or the development of irritation within the veins themselves.

These may require lifestyle or work changes, or medical intervention such as prescription of steroid creams, painkillers or tight stockings to wear during the day to help prevent over-distension of the veins and encourage the better drainage of blood from the leg.

Your GP can advise you if you feel that your veins are becoming troublesome. Often we just want someone experienced to look at our veins and advise that nothing harmful will happen if left alone.

Are there any risks to having varicose veins?

The most commonly seen complication of varicose veins is the damage it causes to the skin.

Irritant components of the blood leak out of the vein wall when over distended. This is due to high pressure of the blood carried within the vein. The leakage from the veins contains proteins capable of irritation and skin injury.

This leakage may only result in a progressively more swollen leg, but as the condition becomes more established, permanent staining of the skin may develop in up to one in ten people. Untreated this damage ultimately leads to a compromise to the nourishment of the skin. With further damage, localised breakdown of the skin and an ulcer may develop in one to two percent of people.

Other complications include the development of thrombosis (clot) in the vein itself and repeated episodes of inflammation of the vein wall which in itself can lead to either infection or thrombosis (phlebitis and thrombophlebitis).

What treatments are available?

Treatment options will vary depending on the severity of the varicose veins. If skin changes are a concern already or other symptoms are impacting upon your health, surgical treatment is recommended.

The majority of surgeons will provide tailor-made treatments based on the nature of your valve or vein failure having examined you. Many treatments are performed without need of a general anaesthetic.

Common Treatments include:

Endovenous surgery -where the faulty vein or veins are closed by treating the vein with radiofrequency ablation or laser ablation.

Ligation the faulty junctions where blood wrongly enters veins lying beneath the skin. This typically requires an incision at the top of the leg or behind the knee.

Removal of veins in long or short segments (stripping, avulsions and microphlebectomies)

Injection of chemical irritants into veins to destroy the vein and close its channel (sclerotherapy). This may be performed in clinic when treating less extensive areas or small-sized varicose veins. This can also be combined with the other treatments mentioned above.

Novel treatments which are currently being evaluated but which have not yet been widely used include injection of polymer glues into the veins.

How can I reduce the chance of getting varicose veins?

There is little evidence to convincingly say that we can prevent people from getting varicose veins if they are prone to their occurrence.

Delaying their onset may be achieved by reducing the work demanded of your veins in everyday life. This may be achieved by avoiding standing still for long periods and using your calf muscle pump mechanism by performing regular toe lift exercises to help circulate the blood from the legs into the pelvis and back to your heart.

Losing weight will reduce the stress on your veins and reduce the pressure on the skin around the lower leg.

Stopping smoking has been found to improve the nourishment of the skin as will a compression stocking worn during the day. Pregnancy often makes previously normal veins fail and repeated pregnancies will accelerate the development of varicose veins.

What made you want to become a consultant?

I wanted to be like the man whom I most respected when I began my training.

I don't want to embarrass him by naming him. I remember his unwavering commitment to his patients and his loyalty to his team. He was a brilliant surgeon who had helped thousands of people. They entrusted him with their lives.

I have a job where I make people better with what I do with my hands which is a huge privilege and honour and I get to work and play alongside a brilliant team of surgeons, doctors and nurses.

What are some of your career highlights to date?

Being awarded a Vascular Society Endovascular Fellowship after my Registrar training enabled me to return to St Thomas' Hospital. This was a very special time for me and I was able to use this unique experience to develop as a sub-specialist in which I practice today.